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The Role of the Physician in Hospice
Published in Bruce Jennings, Ethics in Hospice Care: Challenges to Hospice Values in a Changing Health Care Environment, 2018
As already discussed, physician involvement in the early years of hospice was fairly limited. Hospices would, therefore, engage a single physician, or two if they were fortunate, on a part-time basis, sometimes paid and sometimes volunteer, to provide medical direction to the interdisciplinary team. Activities might include weekly or bi-weekly meetings with the team members to develop and review patients' plans of care, ensuring that patients had prescriptions written for their medications, and, on rare occasions, making home visits. Occasionally, if time permitted, the physician might assist the hospice as a liaison and problem solver with attending physicians, and might be involved in some quality assurance activities (Hadlock 1983, Kinzbrunner 1993).
Communications
Published in J.H.U. Brown, Management in Health Care Systems, 2017
Social questions also enter the final solution. Do patients accept remote consultation? Are they willing to pay for it? Is a face-to-face confrontation with the physician necessary for reinforcement of medical direction? In an era when less than 10% of patients given prescriptions or treatment actually obeys the physician’s orders from his/her office, how can we be sure of adequate remote treatment?
Identity, Role, and Task: A Core Perspective on Pastoral Care with Cardiothoracic Transplantations
Published in William R. DeLong, Organ Transplantation in Religious, Ethical and Social Context: No Room for Death, 2014
This dynamic is borne out over and over in organ transplantation. The patient generally does not have an informed understanding of the rigors of maintenance and treatment, and so looks to professional staff for information and guidance. This automatically creates a hierarchical structure where patients see the professional as “all knowing” and themselves as dependent. Too often the medical professional fosters that dynamic and continues the experience of powerlessness by telling the patient what he or she needs to do rather than sorting through feelings and responses. This is why we put so much emphasis on the quality of “compliance” in modem health care. In the paternalistic view, there is a high value placed on the patient’s compliance (that is, the ability to follow direction) rather than on integration, which I would understand as the ability to gather information and make informed medical decisions. While it is important that the patient comply with medical direction, it is also important that patients weigh the risks and benefits and sort them through with caregivers and loved ones, so that they can take “ownership” of the process and move ahead with self-esteem intact and with a sense of empowerment. When we over-emphasize compliance we fail to discern the patient’s emotional and spiritual orientation and we preclude personal growth and the potential serenity that comes with acceptance and reflective integration. The patient gets “stuck” on feelings, oftentimes in fact experiencing a growing sense of frustration or powerlessness.
Bolus Dose Epinephrine Improves Blood Pressure but is Associated with Increased Mortality in Critical Care Transport
Published in Prehospital Emergency Care, 2019
Francis Xavier Guyette, Christian Martin-Gill, Gabriela Galli, Neal McQuaid, Jonathan Elmer
We performed a retrospective case-cohort study including patients transported by a single large critical care transport network from January 2011 to January 2017. The University of Pittsburgh Institutional Review Board approved all aspects of this study. We include adult patients ≥14 years of age with profound hypotension, defined as a systolic blood pressure (SBP) <70 mmHg obtained by an automated noninvasive blood pressure cuff, by manual assessment, or by an indwelling arterial catheter. Our regional critical care transport network serves a population of roughly 4 million people from 17 bases with rotor wing and ground critical care assets. The system transports 12,000 patients annually, of which 75% are interfacility transports. Transport teams consist of a board certified critical care paramedic (FP-C) and critical care nurse (CFRN). Care is directed by protocol and by online medical direction from a cadre of 14 EMS physicians.
Highlights from the CY 2020 PFS and OPPS Proposed Rules
Published in Oncology Issues, 2019
CMS is proposing to amend the physician supervision requirements of PA services. Specifically, CMS is proposing to allow PAs to provide services in alignment with the state law and scope of practice for where the services are provided. These services would need to be performed under the necessary medical direction and appropriate supervision as outlined by the state. If there are no state laws that address supervision of PA services, the supervision would need to be documented in the medical record to support the PA's work with the physician in furnishing the services. This documentation would need to be available upon request.
2017 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 35th Annual Report
Published in Clinical Toxicology, 2018
David D. Gummin, James B. Mowry, Daniel A. Spyker, Daniel E. Brooks, Krista M. Osterthaler, William Banner
Poison center Managing Directors are primarily responsible for patient care/information service operations, clinical education, and staff instruction. Most are PharmDs or RNs with American Board of Applied Toxicology (ABAT) certification in clinical toxicology. Medical direction is provided by Medical Directors who are board-certified physician medical toxicologists. At some PCs, the Managing and Medical Director roles are held by the same individual.